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目的探讨影响胃癌合并2型糖尿病(T2DM)病人术后糖尿病改善的相关因素。方法回顾性分析2013年1月至2016年7月第二军医大学附属长海医院162例胃癌合并T2DM病人临床及随访资料,包括性别、年龄、糖尿病病程、随访术后血糖变化及用药情况,肿瘤大小、分型、分期、浸润深度、淋巴转移情况,以及胃癌根治手术不同手术方式治疗(Bypass-:BillrothⅠ式吻合、近端胃切除;Bypass+:全胃或远端胃切除+Roux-en-Y吻合),采用CMH及秩和检验进行单因素分析,并对相关因素进行logistic回归分析。结果胃癌合并T2DM病人术后效果与病人年龄、肿瘤大小、手术方式及病程长短存在明显相关性。而与病人性别、术后血糖变化及用药情况、肿瘤分型、分期、浸润深度、淋巴转移情况指数无明显相关性。结论对于胃癌合并T2DM病人,Bypass+有助于改善胃癌术后病人血糖,特别是T2DM病程较短、年龄较小、肿瘤较小病人,以此提高术后短期内糖尿病改善。
Objective To investigate the related factors that affect the improvement of postoperative diabetes in gastric cancer patients with type 2 diabetes mellitus (T2DM). Methods The clinical and follow-up data of 162 patients with gastric cancer complicated with T2DM from January 2013 to July 2016 in Changhai Hospital affiliated to the Second Military Medical University were retrospectively analyzed. The data including the gender, age, duration of diabetes, blood glucose changes and drug use, tumor size , Bypass-: BillrothⅠ anastomosis, proximal gastrectomy; Bypass +: total or distal gastrectomy + Roux-en-Y anastomosis ), Using CMH and rank sum test for univariate analysis, and related factors logistic regression analysis. Results The postoperative effects of gastric cancer with T2DM patients were significantly correlated with patient’s age, tumor size, operation mode and duration of disease. However, there was no significant correlation with patient’s sex, postoperative blood glucose changes and medication, tumor type, stage, depth of invasion, and lymphatic metastasis index. Conclusions Bypass + can help improve the postoperative glycemia in patients with gastric cancer complicated with T2DM. In particular, T2DM has a shorter duration, younger age and smaller tumor size to improve the short-term improvement of diabetes.